Swaddle Bathing & Immersion Tub Bathing System

Instructions for Use (Hospital/Professional version)

DEHP FREE/BPA FREE US & FOREIGN PATENTS PENDING

TurtleTub is approved for use as follows:

1. TurtleTub is a single-infant-use-only product. 2. TurtleTub may be re-used on multiple patients only when used with TurtleTub disposable bath liners and when our multi-patient cleaning instructions are followed. Instructions for Use | TurtleTub™

WARNING:

Drowning Hazard: Babies have drowned while using infant bath tubs. To prevent drowning: • Stay in arm’s reach of your baby. • Never rely on a toddler or preschooler to help your baby or alert you to trouble. Babies have drowned even with other children in or near bath tub. • Babies can drown in as little as 1 inch of water. Use as little water as possible to bathe your baby. • Use tub only on sturdy non-slip surface, in an empty sink, or in an empty adult bathtub. • Keep drain open in adult tub or sink.

Fall Hazard: Babies have suffered head injuries falling from infant bath tubs. To prevent falls: • Place tub only on sturdy non-slip surface, in an empty sink, or in an empty adult bathtub. • Never lift or carry baby in tub.

1 Instructions for Use | TurtleTub™

TurtleTub™ Indications for Use: Intended for infant swaddle bathing. May also be used for immersion tub bathing. For use on infants from preterm to 3 months corrected age.

TurtleTub™ Instructions For Use: 1. Hospital caregivers must don gloves for bathing. 2. Inspect the tub prior to use and discontinue the use of the product if it becomes damaged, broken or disassembled. 3. Encourage parents to bathe infant. 4. Ensure TurtleTub has been cleaned prior to use – see cleaning instructions below. 5. Modify environment as needed to decrease draft and sensory stimuli. 6. Arrange TurtleTub contents for use. A TurtleTub liner is required for multi-patient use. 7. For Single-Patient use: Write infant name on label (on front of tub). 8. For Multiple-patient use: Place TurtleTub bath liner in the tub. 9. Undress infant. 10. If infant has leads, unplug them. The sticky gel portion of the lead can remain on infant. They are easier to remove when wet.

Instructions continue on next page.

2 Instructions for Use | TurtleTub™

11. Position infant with hands near face and swaddle infant with the TurtleTub blanket. See Figure 1.

1. Position the blanket 2. Put the infant’s hands 3. Fold over the horizontally and place the near her face for comfort other side of the infant on the blanket. and fold one side of the blanket. blanket over the infant. Figure 1

12. Fill the TurtleTub with water to a height no greater than the infant’s chest. If using a liner, ensure the liner is smooth (no wrinkles) on the temperature strip. Swirl the water with your hand to equilibrate the temperature throughout the tub. Ensure that the temperature is 101°F-103°F (38°C - 39°C) using the temperature strip. See Figure 2. In addition, test the water with your hand.

Enlarged view of the Figure 2 Temperature Strip

3 Instructions for Use | TurtleTub™

13. Place TurtleTub on a sturdy non-slip surface or on the TurtleTub bathing cart (TT1114). See Figure 3. 14. Fill rinse cup with clean water and place near bathing area. 15. Place swaddled infant in tub. Keep bath time as short as possible (7-10 minutes).

Figure 3

16. Use clean washcloths without cleanser to wash baby’s face. Wash one eye at a time moving from inside corner of eye outward. Use clean section of cloth on each eye. Clean outer ear only. Wash face, neck and behind ears. 17. Gently unswaddle one arm and use cleanser on your gloved hands to wash infant. Parents can use ungloved hands for bathing. Use a firm, but gentle touch. Rinse and re-swaddle. Repeat with all extremities and chest. If infant has chest leads, remove them. Remember to keep infant swaddled throughout the bath.

4 Instructions for Use | TurtleTub™

18. Gently roll infant to side-lying to clean the infant’s back. Clean smaller infants by rubbing on the banket. Unwrap the backside of older infants for cleaning directly on the skin. Reposition infant to supine. 19. Wash genital area with a washcloth and cleanser. 20. Wash infant’s head last to conserve heat. Use TurtleTub scalp brush and cleanser and apply enough pressure to bend the bristles. Use water from the clean rinse cup to rinse the baby’s head. 21. To remove infant from the tub, stand close to the tub with a warm, drying blanket (hospital supplied) secured under your arms. Unswaddle infant and lift infant out of tub and into the warm, hospital blanket on your chest. Pat dry making sure infant’s head is dry. 22. Place infant in the bed on another warm hospital blanket and wrap infant. 23. Prepare infant for skin-to-skin holding or feeding. Or dress and position infant for sleep. 24. Pour out the water from the TurtleTub.

See our educational videos @ www.catapult-products.com

• Overview of Swaddle Bathing & Clinical Benefits • How to Swaddle Bathe in the NICU • Make Swaddle Bathing Easy in the NICU & Well Baby Unit (webinar) • How our Disposable Bath Liners Work • Baby’s Perspective of a Swaddle Bath • Summary of clinical Benefits and intro to TurtleTub • How to Swaddle Bathe at Home (in English and Spanish)

All videos are available for download from our Vimeo site and can be used in your hospital for clinician, family and discharge education.

5 Instructions for Use | TurtleTub™

TurtleTub™ Cleaning Instructions: 1-2 1. Cleaning for single-patient-use: Wash the TurtleTub with gentle soap and water and dry. 2. Cleaning for multi-patient-use: Discard TurtleTub liner. Wash the TurtleTub according to multi-patient equipment hospital protocol – we recommend PDI Sani-Cloth Super (purple top) wipe to clean the tub. Other wipes are acceptable. Please contact us for current approved wipes.

TurtleTub™ Swaddle Bathing Blanket Laundering Recommendations: 1. Wash up to 170° F. 2. Dry 140° F – 150° F for 20 minutes. 3. If bleach is required use only color-safe bleach. 4. Follow CDC Guidelines for Laundry in Healthcare Facilities.

TurtleTub™ Storage: Store the TurtleTub by hanging it in a TurtleTub mesh storage bag (TT1108) or cover the tub between uses.

TurtleTub™ Replacement Recommendation: TurtleTubs used for multi-patient use should be replaced after one year of use.

1. Johnson D, et al. Patients’ bath basins as potential sources of infection: A multicenter sampling study. AJCC. 2009; 18(1): 31-40. 2. Marchaim D, et al. Hospital bath basins are frequently contaminated with multidrug-resistant human pathogens. AJIC Journal. 2012: (40) 562-4.

6 Swaddle Bathing Reference List

1. Anderson GC, et al. Axillary temperature in transitional newborn infants before and after tub bath. Appl Nurs Res. 1995; 8:123-128. 2. Andrews C, Whatley D, Smith M, et al. Quality-Improvement effort to reduce hypothermia among high-risk infants on a mother-infant unit. Pediatrics. 2018;141(3): e20171214. 3. Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN). Neonatal Skin Care: Evidence-based Clinical Practice Guideline. 2018; 41-53. 4. Blume-Peytavi, et al. Skin care practices for newborns and infants: Review of the clinical evidence for best practices. Pediatric Dermatology 2012. 29(1): 1-14. 5. Brogan, J. et al. Implementing evidence-based neonatal skin care with parent- performed delayed immersion baths. Nursing for Women’s Health. 2017; 21(6) 442-450. 6. Bryanton J, et al. Tub bathing versus traditional sponge bathing for the newborn. J Obstet Gynecol Neonatal Nurs. 2004; 33:704-712. 7. Çaka SY, Gözen D. Effects of swaddled and traditional tub bathing methods on crying and physiological responses of newborns. J Spec Pediatr Nurs. 2018;23: e12202 8. Ceylan SS, Bolisik. Effects of swaddled and sponge bathing methods on signs of stress and pain in premature newborns: Implications for Evidence-Based Practice. World Views on Evidence Based Nursing. 2018; 15: 296-303. 9. Cole J, et al. Tub baths or sponge baths for newborn infants? Mother Baby J. 1999;4:39-43 10. Edraki M, et al. Comparing the effects of swaddled and conventional bathing methods on body temperature and crying duration in premature infants: a randomized clinical trial. Journal of Caring Sciences. 2014; 3 (2): 83-91. 11. Fern D, et al, Swaddled bathing in the newborn intensive care unit. Newborn and Infant Nursing Reviews. 2002; 2(1), 3-4. 12. Fernández, D., & Antolín-Rodríguez, R., Bathing a premature infant in the intensive care unit: A systematic review, Journal of Pediatric Nursing (2018) 13. Hall K. Practising developmentally supportive care during infant bathing: reducing stress through swaddle bathing. Infant. 2008; 4(6): 198-201. 14. Loring C, Gregory K, et al. Tub bathing improves thermoregulation of the late preterm infant. J Obstet Gynecol Neonatal Nurs 2012; 41(2): 171-9. 15. Medves JM, O’Brien B. The effect of bather and location of first bath on maintaining thermal stability in newborns. Journal of Obstetric, Gynecologic, and Neonatal Nursing. March 2004; 33(2): 175-182. 16. Quraishy K, et al. A protocol for swaddled bathing in the neonatal intensive care unit. NAINR. 2013; (1): 48-50. 17. World Health Organization, United Nations Population Fund, UNICEF, The World Bank. Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice. 2013.

Manufactured by: CATAPULT PRODUCTS, LLC [email protected] 4677 S. Cherry St., Salt Lake City, UT 84123 www.catapult-products.com PH: 385-212-4933 FAX: 385-234-4850